Senate Joint Resolution 324 introduced by Senator Linda T. Puller during the 2005 General Assembly Session, initially requested that the Joint Legislative Audit and Review Commission study the needs of patients found not guilty by reason of insanity (NGRI) and the impact on the mental health system of individuals found incompetent to stand trial (IST). The resolution was amended to direct the study to the Joint Commission on Health Care (JCHC) through its Behavioral Health Care Subcommittee. This report consists of an executive summary and the presentation made to the Behavioral Health Care (BHC) Subcommittee on September 14, 2006.

The BHC Subcommittee continued its study of NGRI/IST for a second year in 2006. (Study findings and actions taken by JCHC during the first year of the study are detailed in Senate Document 5 – 2006.) In conducting this study, JCHC staff and a study workgroup continued to address the objectives of the NGRI-acquittee system including: protection of public safety by ensuring that acquittees are not released into the community until they are ready for such release; fair treatment in terms of balancing an acquittee’s need for treatment with the curtailment of his freedom, and consideration of the best use of inpatient bed capacity within Virginia’s psychiatric hospitals.

The following legislative options were approved by the Joint Commission, to be taken during the 2007 General Assembly Session:

• Amend Code of Virginia, Title 19.2, Chapter 11 throughout to recognize the role of the CSB/BHA director or director’s designee in outpatient restorations (SB 1103).

• Amend Code of Virginia §19.2-169.3 where the “director of the treating facility" appears to read the “director of the treating facility or his designee" to reflect current practice with regard to completion of reports (SB 1103).

• Amend Code of Virginia §19.2-175 and introduce an accompanying budget amendment to increase the fees provided for evaluations related to sanity and competence issues (SB 965/HB 2368).

• Amend Code of Virginia §19.2-182.6.B to make it clear that the court is required to order the DMHMRSAS Commissioner to appoint two evaluators “to assess and report on the acquittee’s need for inpatient hospitalization" only in instances in which the petitioner for release is the acquittee (SB 1134).

• Amend Code of Virginia, Title 19.2, Chapter 11.1 throughout to:

• Replace the language “the community services board where the acquittee was acquitted" and the language “the community services board serving the locality in which the acquittee will reside" with “the community services board or the behavioral health authority as designated by the Commissioner"

• Add “or behavioral health authority" where community services board appears to recognize the existence of such authorities (SB1104/HB2369).

• Introduce a budget amendment to provide funding to DMHMRSAS for outpatient restorations for adults. (A budget amendment was not introduced since funding was included in the Governor’s introduced budget.)

On behalf of the Joint Commission and staff, I would like to thank the numerous individuals who assisted in this study report, including representatives of community services boards; Department of Mental Health, Mental Retardation and Substance Abuse Services; Indigent Defense Commission; National Alliance for the Mentally III, Virginia; Office of the Attorney General; Psychiatric Society of Virginia and Northern Virginia; Supreme Court of Virginia; University of Virginia Institute of Law, Psychiatry and Public Policy; and Virginia Office for Protection and Advocacy.

Kim Snead
Executive Director
March 2007